Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop.
Sudden cardiac death prediction and prevention: report from a National Heart, Lung, and Blood Institute and Heart Rhythm Society Workshop.
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DOI：
10.1161/circulationaha.110.976092
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发表时间：
2010-11-30
期刊：
影响因子：
37.8
通讯作者：
Zheng ZJ
中科院分区：
文献类型：
--
作者：
Fishman GI;Chugh SS;Dimarco JP;Albert CM;Anderson ME;Bonow RO;Buxton AE;Chen PS;Estes M;Jouven X;Kwong R;Lathrop DA;Mascette AM;Nerbonne JM;O'Rourke B;Page RL;Roden DM;Rosenbaum DS;Sotoodehnia N;Trayanova NA;Zheng ZJ
尽管世纪后半叶冠状动脉疾病（CAD）死亡率显著下降，但心源性猝死（SCD）每年仍夺去25万至30万美国人的生命。2在北美和欧洲，一般人群中SCD的年发病率为50 - 100/100 000。3-6由于世界大多数地区缺乏紧急医疗响应系统，目前无法获得全球范围的估计数字。7然而，即使有先进的第一反应系统用于院外心脏骤停复苏，最近北美分析的总生存率为4.6%。8 SCD可表现为室性心动过速（VT）、心室颤动（VF）、无脉性电活动（PEA）或心搏停止。在相当大比例的患者中，SCD可以在没有警告或公认的触发机制的情况下出现。这些患者的平均年龄在60多岁，至少40%的患者在65岁之前患有SCD。因此，加强SCD的预测和预防方法对于管理这一重大公共卫生问题具有独特的关键重要性。SCD的预测和预防是一个积极的研究领域，但仍然存在相当大的挑战，限制了现有方法的有效性和成本效益。7，9，10早期就认识到SCD风险分层的优化需要在实验室和床边整合多学科的努力，并在普通人群中进行研究。11-13这一整合尚未有效完成。也有越来越多的认识，需要更多的调查，以确定SCD的早期预测。14在遗传性通道病变15 -17和其他易患SCD的遗传性疾病（如肥厚性心肌病）18的风险预测方面已经取得了重大进展，但在CAD患者中更常见的复杂表型（如SCD）方面仍有许多工作要做。许多心血管治疗（例如，降脂和抗高血压药物、抗缺血干预和心力衰竭治疗）可预防或延迟心血管疾病的进展，心血管疾病是SCD的最常见原因。然而，目前的研讨会专门侧重于心脏病人群中猝死的风险预测，而不是更广泛的预测和预防心脏病的主题。不幸的是，针对导致心律失常的电生理底物和机制的特定药理学治疗已被证明是令人失望的，当应用于高或中度风险患者，没有事先记录的临床心律失常。植入式心律转复除颤器（ICD）联合心力衰竭药物治疗仍然是SCD预防的主要手段19，20，但可能仅对SCD事件发生前可识别的少数高危人群有益。第五、二十一章
Despite the significant decline in coronary artery disease (CAD) mortality in the second half of the 20th century, 1 sudden cardiac death (SCD) continues to claim 250 000 to 300 000 US lives annually. 2 In North America and Europe the annual incidence of SCD ranges between 50 to 100 per 100 000 in the general population. 3–6 Because of the absence of emergency medical response systems in most world regions, worldwide estimates are currently not available. 7 However, even in the presence of advanced first responder systems for resuscitation of out-of-hospital cardiac arrest, the overall survival rate in a recent North American analysis was 4.6%. 8 SCD can manifest as ventricular tachycardia (VT), ventricular fibrillation (VF), pulseless electric activity (PEA), or asystole. In a significant proportion of patients, SCD can present without warning or a recognized triggering mechanism. The mean age of those affected is in the mid 60s, and at least 40% of patients will suffer SCD before the age of 65. 4 Consequently, enhancement of methodologies for prediction and prevention of SCD acquires a unique and critical importance for management of this significant public health issue. Prediction and prevention of SCD is an area of active investigation, but considerable challenges persist that limit the efficacy and cost-effectiveness of available methodologies. 7, 9, 10 It was recognized early on that optimization of SCD risk stratification will require integration of multi-disciplinary efforts at the bench and bedside, with studies in the general population. 11–13 This integration has yet to be effectively accomplished. There is also increasing awareness that more investigation needs to be directed toward identification of early predictors of SCD. 14 Significant advancements have occurred for risk prediction in the inherited channelopathies15–17 and other inherited conditions that predispose to SCD, such as hypertrophic cardiomyopathy, 18 but there is much to be accomplished in this regard for the more common complex phenotypes, such as SCD, among patients with CAD. Many cardiovascular treatments (eg, lipid lowering and antihypertensive agents, antiischemic interventions, and heart failure therapies) prevent or delay the progression of the cardiovascular diseases that are the most frequent cause of SCD. However, the current workshop focused specifically on risk prediction for arrhythmic death in cardiac populations rather than on the broader topics of prediction and prevention of cardiac diseases in general.Unfortunately, specific pharmacological therapies directed at the electrophysiological substrate and mechanisms that cause arrhythmias have proven disappointing when applied to high or moderate risk patients without prior documented clinical arrhythmias. The implantable cardioverter-defibrillator (ICD) in combination with heart failure drug therapy remains the mainstay of SCD prevention19, 20 but is likely to benefit only the small population at high risk who can be identified before an SCD event. 5, 21